The proposed research will replicate the study of Rush, et al (1977) which showed cognitive therapy to be more effective than a tricyclic antidepressant (TCA) in the treatment of outpatients suffering from depression of the primary affective disorder, unipolar type. This is the first comparison study to find any form of psychotherapy by itself to be superior to a TCA in the treatment of clinical depression. The overall objectives of the proposed research are threefold: 1) to replicate Rush's study; 2) to compare combined therapy, controlled for expectancy regarding medication; 3) to restudy our patients at intervals to determine outcomes. REPLICATION: We will use the same diagnostic criteria as used by Rush, the same criteria of severity of depression, the same treatment protocol and mostly the same additional measures of patients' state and adjustment in order to permit comparisons between, as well as within studies. Our patient population is of a lower socioeconomic status than that of Rush, et al. COMBINED TREATMENT: In addition to replicating Rush's work, we will simultaneously treat two other groups of patients selected in the same way. One group will receive cognitive therapy combined with nortriptyline; the other, cognitive therapy combined with simulated nortriptyline (placebo) to which both patient and therapist will be blind. The effectiveness of combined therapy (psychotherapy plus antidepressant therapy) compared with either treatment alone has not been studied. It is necessary to control for expectancy effects on the parts of patient and therapist with respect to medication. We plan to follow up all patients entered into the study at four weeks, three months, six months and one year post treatment to determine outcome according to the measures used by Rush, et al.